title: Geographic variation in ambulatory electronic health record adoption: implications for underserved communities.
abstract: OBJECTIVE
  To describe small area variation in ambulatory electronic health record (EHR) adoption and assess evidence of a "digital divide" in whether adoption is lagging in traditionally underserved communities.
  
  
  METHODS
  Survey data on U.S. ambulatory health care sites (261,973 sites representing 716,160 providers) collected by SK&A Information Services in 2011.
  
  
  METHODS
  We examined cross-sectional variation in two measures of local area EHR adoption: share of providers at sites using an EHR with e-prescribing functionality; and predicted probability of EHR adoption for the average site. Local areas were defined as Public Use Microdata Areas (n = 2,068). Using multivariate regression, we examined the association between adoption and three area characteristics: high concentration of minority population; high concentration of low-income population; and metropolitan status.
  
  
  RESULTS
  EHR adoption varied significantly across local areas, ranging from 8 to 88 percent with a median of 41 percent. Adoption was lower in large metropolitan areas; areas with high concentration of minority population in the Northeast and West; and areas with high concentration of low-income population in the Midwest.
  
  
  CONCLUSIONS
  Our 2011 estimates suggest there was substantial room for increased EHR adoption across the United States, including some underserved areas with relatively low EHR adoption rates. Further research should monitor policy initiatives in these areas and examine sources of heterogeneity in low- and high-adoption communities.
authors.affiliation: Office of the National Coordinator for Health Information Technology, Washington, DC.
authors.forename: Jennifer
authors.initials: J
authors.lastname: King
authors.forename: Michael F
authors.initials: MF
authors.lastname: Furukawa
authors.forename: Melinda B
authors.initials: MB
authors.lastname: Buntin
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D055695:Electronic Prescribing / Q000706:statistics & numerical data; D006801:Humans; D008507:Medically Underserved Area; D012111:Residence Characteristics / Q000706:statistics & numerical data*
keywords: Electronic health records; ambulatory care; geographic variation; underserved populations